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SAN JOAQUIN COUNTY <br /> I NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: J) II III PHS-EH LOG # <br /> (Circle One) <br /> Be SOURCE OF INFORMATION <br /> Original Source: Telephone: Q12LD <br /> Reporting Agency Name — <br /> Agency Contact: Te ephone: l yGS-- 3S/ <br /> Address : <br /> co LOCATION AND DATE OF DISCCH^ARGE <br /> Location: - l/j k/, <br /> (Best Physical De cription) (City or County <br /> i <br /> Date of Discharge: <br /> Date Notified. o / 7 — ?s"% Time : /G : "lig d'L <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business _ <br /> Contact Person: Telephone: <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume : Z <br /> Chemicals : <br /> F. ACT ON TAKEN <br /> 00 <br /> ev <br /> oe <br /> G <br /> El-I VOe . <br />